Rokurony of a kaba

General characteristics. Structure:

Active ingredient: 10 mg bromide rokuroniya.

Excipients: sodium chloride, acetate sodium trihydrate, acetic acid ice (for correction pH), water for injections.

Pharmacological properties:

Pharmacodynamics. Rokurony Kabi (a rokuroniya bromide) - not depolarizing muscle relaxant, with short (is closer to average) action durations, having all pharmacological effects (kurarepodobny), inherent to this class of medicinal substances. It competitively blocks nicotinic holinoretseptor of the motive terminations. Antagonists of this effect are holinosteraza inhibitors, such as a neostigmina methyl sulfate, an edrofoniya chloride and pyridostigmine bromide. ED90 (the dose necessary for suppression for 90% of reflex movement of a thumb of a brush in response to stimulation of an elbow nerve) at the balanced anesthesia makes about 0,3 mg/kg of body weight.

During 60 from later intravenous administration a bromide rokuroniya in a dose of 0.6 mg/kg of body weight (2 × ED90 at the balanced anesthesia) adequate conditions for an intubation are created practically at all patients. In 80% of cases they are the best. Within 2 minutes the general mioplegiya develops. which allows to carry out any interventions. Duration of clinical effect of drug (before spontaneous recovery of extent of muscular contractions to 25% of reference level) after introduction of this dose makes 30-40 minutes. The general duration of action (time before recovery of extent of muscular contractions to 90% of reference level) - 50 minutes. The average time of spontaneous recovery of extent of muscular contractions from 25% to 75% of reference level (a recovery index) after introduction the bromide rokuroniya in the form of a bolus of 0,6 mg/kg of body weight makes 14 minutes.

At introduction the bromide rokuroniya in smaller doses of 0.3-0.45 mg/kg (1-1,5 (ED90)) action begins more slowly and its duration decreases (13-26 minutes). After introduction a bromide rokuroniya in a dose of 0,45 mg/kg of body weight adequate conditions for an intubation are created during 90 pages.

At bystry induction of anesthesia propofoly or fentanyl / тиопентапом sodium adequate conditions for an intubation after introduction a bromide rokuroniya in a dose of 1,0 mg/kg are created during 60 with at 93% and 96% of patients, respectively. In 70% of cases they are the best. Duration of clinical action of this dose reaches 1 h. To the specified term neuromuscular blockade can be safely eliminated. After introduction a bromide rokuroniya in a dose of 0.6 mg/kg adequate conditions for an intubation are created during 60 with at 81% and 75% of patients which apply to induction of anesthesia пропофол or sodium fentanyl/thiopental, respectively.

Use the bromide rokuroniya in doses does not lead more than 1.0 mg/kg of body weight to significant improvement of conditions for an intubation, however action duration at the same time increases. Doses of more than 4 × ED90 were not studied.

When maintaining patients in intensive care units a rokuroniya bromide appoint 0.6 mg/kg in a dose. and then in the form of the supporting continuous infusion with a speed of 0.2-0.5 mg/kg/h within the first hour when extent of muscular contractions is recovered to 10% of reference level or 1-2 answers when monitoring in the mode of four-digit stimulation (TOF-train of four stimulation) appear. Doses are titrated individually, in the subsequent they need to be reduced under constant control of TOF. Use duration - 7 days.

Such mode of dosing leads to development of adequate muscle relaxation. however considerable variability of speed of infusion and increase in duration of blockade is noted.

Time before recovery of TOF to 0.7 authentically does not depend on the general duration of introduction a bromide rokuroniya. After continuous infusion during 20 h and more median (range) of time between emergence of the second answer to TOF stimulation and recovery of TOF of the relation to 0.7 makes from 0.9 to 12 h at patients without multiorgan insufficiency and patients have 1.2-25.5 h with multiorgan insufficiency.

At newborns and children the average speed of the beginning of action of a dose of 0.6 mg/kg is higher, than at adults. Duration of effect of drug at children is less, than at adults. Duration of action of maintenance doses a rokuroniya of bromide of 0.15 mg/kg can increase a little in the conditions of an anesthesia enflurany and to an izofl Rahn at elderly people and patients with diseases of a liver or kidneys (about 20 minutes) in comparison with that at patients without abnormal liver function and kidneys during an intravenous anesthesia (about 13 minutes).

At the subsequent introduction of the recommended maintenance doses of cumulation of effect (the progressing increase in duration of action) it is not noted. When carrying out cardiovascular operations the most frequent changes observed at patients during development of the maximum blockade after introduction of 0.6-0.9 mg/kg of body weight are small and clinically insignificant increases in heart rate (for 9%) and increase in the average ABP (for 16%) in comparison with control values.

Pharmacokinetics. Contacts proteins of plasma for 30%. Gets through a placental barrier.

After single introduction the bromide rokuroniya in the form of a bolus, dependence of its concentration in plasma from time was exponential and consisted of three phases. At healthy adults average T1/2 (95% of DI) makes 73 (66-80) minutes, the seeming distribution volume in an equilibrium state makes 203 (193-214) ml/kg, and clearance of plasma - 3.7 (3.5-3.9) ml/kg/min.

The clearance from plasma at elderly people and patients with a renal failure decreases in comparison with that at more young people with normal function of kidneys a little. Patients with diseases of a liver have an average period of T1/2 for 30 minutes, and the average clearance from plasma decreases by 1 ml/kg/min.

Distribution volume at newborns (3-12 months) is higher, than at children of advanced age (1-8 years) and adults.

At children at the age of 3-8 years the clearance is higher, and T1/2 about 20 minutes shorter, than at adults and children under 3 years.

At continuous infusions during 20 h and more during artificial ventilation of the lungs average T1/2 and average volume of distribution in an equilibrium state increases.

The high interindividual variability connected with character and degree of multiorgan insufficiency and individual obennost of patients is noted. At patients with multiorgan insufficiency average T1/2 (±SD) made 21.5 (±3.3) h, distribution volume in an equilibrium state - 1.5 (±0.8) l/kg. the clearance - 2.1 (±0.8) ml/kg/min. of Rokuroniya bromide is brought out of plasma with urine and bile.

Extent of removal with urine reaches 40% during 12-24 h, 47% are removed with a stake. About 50% of a dose are removed in a look a bromide rokuroniya. Metabolites in plasma are not revealed.

Indications to use:

It is applied at adults and children is more senior than 3 months:

— during the general anesthesia, for simplification of an intubation of a trachea at standard and bystry successive induction of anesthesia;

— for muscle relaxation during surgical interventions.

In the intensive care units (ICU) for a short-term muscular relaxation (for example, for simplification of an intubation).

Route of administration and doses:

Intravenously in the form of a bolus or continuous infusion.

Dose bromide rokuroniya, as well as other muscle relaxants. it is necessary to select individually.

At the choice of a dose it is necessary to consider a method of the general anesthesia and the estimated expected operation duration, a method of sedation and estimated duration of artificial ventilation, a possibility of interaction with other medicines and a condition of the patient. It is recommended to apply tool control methods to assessment of neuromuscular blockade and recovery of neuromuscular transfer.

Means for an inhalation anesthesia strengthen миорелаксирующес action a bromide rokuroniya. This effect has clinical value during an inhalation anesthesia when in fabrics a certain concentration of volatiles is reached. Respectively, at a long inhalation anesthesia (more than 1 h) it is necessary to enter smaller maintenance doses a bromide rokuroniya with big intervals or to reduce drug infusion speed.

The general recommendations about the dosing mode a bromide rokuroniya are included below at an intubation of a trachea and muscle relaxation during short and long surgical interventions and in intensive care units.

Rokuroniya bromide is intended only for single use.

Surgical interventions. Trachea intubation:

The standard dose a bromide rokuroniya at a usual anesthesia makes 0.6 mg/kg of body weight. This dose provides adequate conditions for an intubation during 60 with almost at all patients.

At bystry successive induction of anesthesia use a bromide rokuroniya in a dose of 1.0 mg/kg of body weight is recommended.

After use of the specified dose adequate conditions for an intubation are also created during 60 with almost, at all patients. If at bystry successive induction of an anesthesia a rokuroniya bromide is appointed in a dose of 0.6 mg/kg. that an intubation should be carried out through 90 from later administration of drug.

Maintenance doses. The recommended maintenance dose a rokuroniya of bromide makes 0.15 mg/kg of body weight. At a long inhalation anesthesia it should be lowered to 0.075-0.1 mg/kg of body weight. It is the best of all to enter a maintenance dose while extent of muscular contractions is recovered to 25% of reference level or at emergence of 2-3 answers when monitoring in the mode of four-digit stimulation (TOF).

Continuous iifuziya. Drop introduction the rokuroniya of bromide is recommended to begin 0.6 mg/kg of body weight with a load dose.

When neuromuscular blockade begins to be recovered, begin continuous infusion of drug. Speed of infusions is selected so that to support extent of muscular contractions at the level of 10% of control value or to support 1-2 answers when monitoring in the TOF mode.

At an intravenous anesthesia at adult patients the speed of infusions. necessary for maintenance of neuromuscular blockade at the specified level, makes 0.3-0.6 mg/kg/h.

At an inhalation anesthesia the speed of infusions makes 0,3-0.4 mg/kg/h.

It is necessary to control constantly extent of neuromuscular blockade as the necessary speed of infusions differs at different patients and depends on an anesthesia method.

The dosing mode at children. At children the recommended doses a bromide rokuroniya are more senior than 3 months at an intubation during an inhalation anesthesia and maintenance doses are similar to those at adults and makes 0.3-0.6 mg/kg/h and at an inhalation anesthesia - 0.3-0.4 mg/kg/h. Speed continuous infusions at teenagers same. as at adults, however higher speed of infusion can be required by children.

At children infusion is begun with the same speed, as at adults. Further the speed of infusion is selected to support extent of muscular contractions at the level of 10% of control value or to support 1-2 answers when monitoring in the mode of four-charging stimulation (TOF).

Experience of use a bromide rokuroniya at children at bystry successive induction of an anesthesia is limited. In this regard the rokuroniya is not recommended to apply bromide at children to simplification of an intubation of a trachea at bystry introduction to an anesthesia. About uses a bromide rokuroniya newborns aged up to 1 month have no data.

The dosing mode at elderly people and patients with diseases of a liver, bilious ways and/or a renal failure. The standard intubation dose a bromide rokuroniya at an inhalation anesthesia at elderly people and patients with diseases of a liver, bilious ways and/or a renal failure makes 0.6 mg/kg of body weight. At bystry successive induction of anesthesia at patients at whom duration of effect of drug increases the dose can also make 0.6 mg/kg. however, adequate conditions for an intubation can be created only through 90 from later introduction a bromide rokuroniya. Irrespective of a method of the general anesthesia the recommended maintenance dose the rokuroniya of bromide makes 0.075-0.1 mg/kg. and infusion speed - 0.3-0.4 mg/kg/h.

The dosing mode at patients with obesity. At patients with obesity (body weight for 30% and more exceeds ideal) it is necessary to lower a dose taking into account weight without fatty tissue.

Intensive care. Intubation bang. At a trachea intubation a rokuroniya of bromide apply in the same doses, as at surgical interventions.

Dosage at maintenance of artificial ventilation of the lungs. It is recommended to begin 0.6 mg/kg of body weight with a dose, and at recovery of neuromuscular conductivity to 10% or obtaining 1-2 answers at stimulation in the Tofnachat mode to enter intravenously in the form of a bolus or continuous infusion. Doses a rokuroniya of bromide have to be picked up individually. The recommended rate of administering at adult patients of 0.3-0,6 mg/kg/h within the first hour then, for 6-12 hours it is necessary to reduce rate of administering, according to individual reaction of the patient.

Rokurony Kabi contains less than 1 mmol of sodium (23 mg) in one dose, i.e. insignificant amount of sodium.

Features of use:

Use at pregnancy and feeding by a breast. Experience of use a bromide rokuroniya at pregnancy is limited. Bromide pregnant women should appoint Rokuroniya only at emergency if the doctor considers that the advantage of its use exceeds possible risk.

At Cesarean section a rokuroniya bromide is recommended to appoint 0.6 mg/kg in a dose. as the dose of 1.0 mg/kg at pregnant women was not studied.

Use the bromide rokuroniya in a dose of 0.6 mg/kg during Cesarean section does not exert impact on an index on a scale Apgar. muscle tone of the newborn and adaptation of function of cardiovascular and respiratory system.

Magnesium salts which apply to treatment of toxicosis at pregnant women strengthen neuromuscular blockade and can inhibit recovery of neuromuscular transfer after use of muscle relaxants. Respectively, in such cases it is necessary to lower a dose a rokuroniya of bromide and to titrate it taking into account extent of muscular contractions. Rokuroniya bromide restrictedly gets through a placenta that does not lead to undesirable reactions at newborns.

The women nursing have experience of use no bromide rokuroniya. Other drugs of this class in a small amount are removed with breast milk and soaked up at the newborn nursed.

The decision on expediency of the termination of feeding by a breast should be made taking into account importance of breastfeeding and potential risk for the child.

Use at abnormal liver functions. With care at an abnormal liver function.

Use at renal failures. With care at a renal failure.

Use for children. It is contraindicated to children up to 3 months.

At children the recommended doses a bromide rokuroniya are more senior than 3 months at an intubation during an inhalation anesthesia and maintenance doses are similar to those at adults and makes 0.3-0.6 mg/kg/h and at an inhalation anesthesia - 0.3-0.4 mg/kg/h. Speed continuous infusions at teenagers same. as at adults, however higher speed of infusion can be required by children.

At children infusion is begun with the same speed, as at adults. Further the speed of infusion is selected to support extent of muscular contractions at the level of 10% of control value or to support 1-2 answers when monitoring in the mode of four-charging stimulation (TOF).

Experience of use a bromide rokuroniya at children at bystry successive induction of an anesthesia is limited. In this regard the rokuroniya is not recommended to apply bromide at children to simplification of an intubation of a trachea at bystry introduction to an anesthesia. About uses a bromide rokuroniya newborns aged up to 1 month have no data.

Use for elderly patients. With care at advanced age.

Special instructions. Bromide doctors, the having experience of use of muscle relaxants have to enter Rokuroniya. It is necessary to have means for an intubation of a trachea and artificial ventilation of the lungs.

Rokuroniya bromide causes paralysis of respiratory muscles therefore at its use it is necessary to carry out artificial ventilation of the lungs until independent breath is recovered.

As well as at use of other muscle relaxants. it is important to expect possible difficulties at an intubation, especially at bystry successive induction of an anesthesia. After introduction a bromide rokuroniya, as well as other muscle relaxants. existence of residual curarization is noted. To avoid the complications connected with residual curarization. it is recommended to stop an intubation only after adequate recovery of neuromuscular transfer.

It is also necessary to consider other factors which can cause residual curarization after extubation in the postoperative period (for example, interaction with other drugs or a condition of the patient). In this situation it is necessary to discuss a possibility of use of the drugs recovering neuromuscular transfers), especially when the probability of residual curarization is increased. Before to transport the patient after an exit from an anesthesia, it is necessary to be convinced of that. that spontaneous, deep and regular breath was recovered. After introduction of muscle relaxants anaphylactic reactions can develop. In this regard it is always necessary to take precautionary measures, especially if anaphylactic reactions arose earlier at administration of other drugs of this group, considering a possibility of cross-responsiveness.

Rokuroniya bromide in a dose more than 0,9 mg/kg can cause increase in heart rate. This effect can level a bratsikardiya. developing under the influence of anesthetics or stimulation of a vagus nerve.

After prolonged use of muscle relaxants in intensive care units noted development of paralysis and/or weakness of skeletal muscles. To avoid possible lengthening of neuromuscular blockade and/or overdose, at use of muscle relaxants it is strongly recommended to control neuromuscular transfer. Besides, it is necessary to provide an adequate analgesia and sedation. Doses of muscle relaxants have to be selected individually under control of experienced doctors on the basis of monitoring of neuromuscular transfer.

Rokuroniya bromide is always applied in combination with other medicines.

Considering a possibility of development of a malignant hyperthermia during an anesthesia even in the absence of the known triggers, doctors have to know precursory symptoms of its manifestation, methods, uiaipopiki and treatments.

At prolonged use of not depolarizing muscle relaxants and kortikoyeteroid observed development of a myopathy. thus, it is necessary to appoint the combined therapy to shorter term.

Rokuroniya bromide can be entered only after a complete recovery of the neuromuscular blockade caused by succinylcholine.

Instruction for preparation and introduction:

— Solution should be entered immediately after opening of a bottle.

— Before introduction solution should be examined. It is possible to enter only transparent solution which is not containing mechanical inclusions.

— Compatibility a bromide rokuroniya from 0.9% by solution of sodium of chloride and 5% dextrose solution for intravenous administration is established.
After cultivation, solution of 5 mg/ml and 0.1 mg/ml (divorced 0.9% solution of sodium of chloride or 5% dextrose solution) chemically is also physically stable during 24 h at the room temperature in glass bottles and bags from polyethylene or polyvinylchloride.

— If a rokuroniya bromide and other medicines are administered through one infuzionnuto system, then it needs to be washed out (for example, 0.9% chloride sodium solution) between administration of drugs. It is necessary when a rokuroniya bromide and other drugs are incompatible, or their compatibility is not established.

— The remains of solution and other waste should be destroyed according to the existing requirements.

If solution is prepared in the conditions of an asepsis, then it is possible to store it no more than 24 h at a temperature from 2 to 8 °C.

Precautionary measures at use:

— Diseases of a liver and bilious ways and почечнеш insufficiency. As the rokuroniya bromide is removed with urine and bile, it should be applied carefully at patients with serious diseases of a liver and bilious ways and/or a renal failure. At such patients increase in duration of action a bromide rokuroniya in a dose of 0.6 mg/kg is observed.

— Increase in time of circulation. The states which are followed by circulation delay such as cardiovascular diseases, advanced age and edematous syndrome, cause increase in volume of distribution that can lead to the slowed-down beginning of action.

— Neuromuscular diseases. As well as other muscle relaxants. a rokuroniya bromide should be applied with exclusive care at patients with neuromuscular diseases or after poliomyelitis, the hook as in such cases can change considerably the response to neuromuscular blockade. Expressiveness and the direction of these changes vary over a wide range. The rokuroniya bromide can cause the expressed effect in low doses therefore its dose should be selected individually in patients with a myasthenia or myasthenic syndrome (Eaton-Lambert's syndrome).

— Hypothermia. At surgical interventions in the conditions of a hypothermia the neuromuscular blocking effect the rokuroniya of bromide amplifies, and duration of its action increases.

— Obesity. If dose bromide rokuroniya, as well as other muscle relaxants. at patients is calculated with obesity on the basis of the actual body weight, increase in duration of its action and the slowed-down recovery of neuromuscular transfer is possible. Therefore the dose is calculated, proceeding from ideal body weight.

— Burns. At patients with burns development of resistance to not depolarizing muscle relaxants is possible. The dose is recommended to be selected individually taking into account response of the patient.

— States which can strengthen action a bromide rokuroniya. A hypopotassemia (for example, after heavy vomiting, diarrhea or diuretic therapy), a gipermagniyemiya. a hypocalcemia (after massive transfusions), a hypoproteinemia. dehydration, acidosis, hypercapnia and cachexia.

Whenever possible it is necessary to achieve correction of heavy electrolytic frustration, changes рН blood and dehydrations.

Influence on ability to driving of motor transport and to control of mechanisms. Rokuroniya bromide exerts the expressed impact on ability to drive the car and to use a difficult technique. In the first 24 h after a complete recovery of the neuromuscular blockade caused rokuroniy by bromide it is not recommended to drive the car and difficult mechanisms.

Side effects:

On frequency undesirable effects are divided into the following categories:

Very frequent	> 1/10
Frequent	> 1/100 - 1/10
Infrequent	> 1/1 000 - 1/100
Rare	> 1/10 000 - 1/1 000
Very rare	<1/10 000
It is not known	It is impossible to estimate on the basis of the available data

The main undesirable effects - pain/reaction in an injection site, changes of the vital indicators and long peyromyshechny blockade.

Disturbances from immune system. Very rare: anaphylactic reaction, for example, acute anaphylaxis, anafilaktoidiy reactions *, hypersensitivity.

Disturbances from a nervous system. Very rare: paralyzes.

Disturbances from cardiovascular system. Very rare: tachycardia, lowering of arterial pressure, collapse and shock.

Disturbances from respiratory system. Very rare: bronchospasm. Frequency is not known: apnoea, respiratory insufficiency

Disturbances from integuments. Very rare: rash, eritsmatozny rash, Quincke's disease, small tortoiseshell, itch, dieback.

Disturbances from a musculoskeletal system. Frequency is unknown: weakness of skeletal muscles, steroid миопатия*.

Local reactions. Very frequent: pain/reaction in an injection site *

Disturbances from laboratory indicators of blood. Very rare: increase maintenance of a histamine *

Injuries, poisonings and complications of procedures. Very rare: long neuromuscular blockade *

* Additional information on undesirable reactions:

Anaphylactic reactions. The heavy anaphylactic reactions caused by muscle relaxants. in certain cases came to an end with death.

Considering possible weight of similar reactions, it is always necessary to consider risk of their development and to take the appropriate measures of precaution.

Reactions in an injection site. At bystry introduction to an anesthesia observed pain in the place of an injection, especially when the patient still finally did not faint, and to induction of an anesthesia it was applied пропофол. In clinical trials pain in the place of an injection was noted at 16% of patients by which carried out bystry induction of anesthesia propofoly. and less than at 0.5% of patients at whom for this purpose applied fentanyl and thiopental of sodium.

Increase in maintenance of a histamine. Muscle relaxants are capable to cause local and system allocation of a gisgamin therefore at use of these drugs it is necessary to consider a possibility of emergence of an itch and development of erythematic reaction in an injection site and/or generalized anafilaktoidiy reactions, such as a bronchospasm and changes from cardiovascular system (arterial hypotonia and bradycardia). At the patients receiving a rokuroniya bromide rash, a dieback, a small tortoiseshell, a bronchospasm and arterial hypotonia were very seldom observed.

In clinical trials after bystry introduction a bromide rokuroniya in the form of a bolus of 0.3-0.9 mg/kg of body weight noted insignificant increase in level of a histamine in plasma.

Long neuromuscular blockade. The most frequent side effect of all class of not depolarizing muscle relaxants is undesirable increase in duration of action which varies from weakness of skeletal muscles to the expressed and their long paralysis leading to development of respiratory insufficiency and an apnoea.

Interaction with other medicines:

The following medicines exerted impact on degree and/or duration of action of not depolarizing muscle relaxants:

Usipeniye of effect:

— Inhalation anesthetics: halothane, diethyl ether, энфлуран, изофлуран, метоксифлуран, cyclopropane;

— Not inhalation anesthetics: high doses of thiopental of sodium, metogeksital, Ketaminum, fentanyl, sodium hydroxybutyrate, etomidat and propofola;

— Other not depolarizing muscle relaxants;

— Previous use of succinylcholine;

— Prolonged treatment by corticosteroids and rokuroniy bromide in the intensive care units (ICU) can lead to increase in duration of neuromuscular blockade or a myopathy;

— Drugs of other groups: antibiotics (aminoglycosides, linkozamida (lincomycin and clindamycin), polypeptide antibiotics, acylaminopenicillin, tetracyclines), high doses of metronidazole, diuretics, thiamin, monoamipooksidaza inhibitors, quinidine, quinine, protamin sulfate, adrenoblockers, magnesium salts, blockers of "slow" calcium channels, salts of lithium and local anesthetics (lidocaine intravenously, epidurapyyua administration of bupivacaine);

Easing of effect:

— Neostigmin, edrofony, pyridostigmine, aminopyridine derivatives;

— Previous therapy by corticosteroids, Phenytoinum or carbamazepine;

— Noradrenaline, азатиоирин (only passing and limited effect), theophylline, Calcii chloridum, potassium chloride;

— HIV protease inhibitors.

Variable effect:

Use of other not depolarizing muscle relaxants in a combination with rokuroniy bromide can lead to easing or strengthening of neuromuscular blockade depending on an order of their use and like a miorelaksait.

The rokuroniya of bromide can lead use of succinylcholine before introduction to strengthening or suppression of myorelaxation effect a bromide rokuroniya.

Influence a bromide rokuroniya on effects of other drugs:

Rokuroniya bromide can accelerate the beginning of effect of lidocaine.

The rekurarization against the background of postoperative use of aminoglycosides was noted. linkozamid, polypeptides and acylaminopenicillin. quinidine. quinine and salts of magnesium.

Pharmaceutical interaction. Incompatibility. Physical incompatibility a bromide rokuroniya with the solutions containing the following medicines is established: V.'s Amphotericinum amoxicillin. Azathioprinum. cefazolin. клоксациллин. dexamethasone. diazepam. эноксимон. erythromycin, фамогидин. furosemide. sodium hydrocortisone succinate. insulin, интрашпид. metogeksitat. Methylprednisolonum. sodium Prednisolonum succinate. sodium thiopental, Trimethoprimum and Vancomycinum.

Compatibility when mixing with other medicines. Rokuroniya bromide in nominal concentration of 0.5 mg/ml and 2.0 mg/ml is compatible from 0.9% solution of sodium of chloride, 5% a dextrose in 0.9% chloride sodium solution, water for injections, Ringer's solution. Introduction has to be begun at once after mixing and is finished within 24 hours. Unused solutions should be destroyed.

Rokuroniya bromide can be entered through system for intravenous infusion together with solutions of the following drugs for intravenous administration: Epinephrinum, an alkuroniya of chloride, alfentanil, Aminophyllinum an atrakuriya of a bezilat, atropine, a ceftazidime, a tsefuroksim, Cimetidinum, Clemastinum, clindamycin, a klometazol, clonazepam, a clonidine, a danaparoid of sodium, Dobutaminum, a dopamine, Droperidolum, ephedrine, ergotamine, an esmolol, an etomidat, fentanyl, a flutsitozin, a gallamin of a trietyodid, gentamycin, 40% of solution of a dextrose, a glikopirroniya of bromide, heparin, an izoprenalin, Ketaminum, a labetalol, lidocaine, 20% of solution of Mannitolum, Metoclopramidum, a metoprolol, metronidazole, midazolam, a milrinon, morphine, nifedipine, a nimodipin, nitroglycerine, Norepinephrinum, oxytocin, a pankuroniya of bromide, pethidine, a pipekuroniya of bromide, potassium of chloride, promethazine, a propanolol, ranitidine, salbutamol, Natrii hydrocarbonas of Sodium nitroprussidum, sufentanil, succinylcholine, a vekuroniya of bromide, verapamil, and also with Geloplazm's drug balance.

Contraindications:

— anaphylactic reactions on rokurony or bromine in the anamnesis;

— children's age up to 3 months.

Overdose:

In case of overdose and long neuromuscular blockade it is necessary to continue ventilation of the lungs and sedation. When spontaneous recovery of neuromuscular transfer begins, it is necessary to enter acetylcholinesterase inhibitor (for example, неостигмин, edrofoniya, pyridostigmine) in an adequate dose.

If administration of inhibitor of acetylcholinesterase is not led to elimination of effect by a bromide rokuroniya, it is necessary to continue artificial ventilation of the lungs until then. yet spontaneous breath will not be recovered. Repeated administration of inhibitor of acetylcholinesterase can be dangerous.

Storage conditions:

To store at a temperature from 2 to 8 °C. To store in the place, unavailable to children. A period of validity - 3 years. Storage is allowed at a temperature up to 30 °C within 12 weeks after which drug cannot be used! Unused solution has to be destroyed according to the existing requirements of the utilization of drugs accepted in this hospital.

Issue conditions:

According to the recipe

Packaging:

5 ml - bottles of colourless glass (5) - a pack cardboard.
5 ml - bottles of colourless glass (10) - a pack cardboard.
10 ml - bottles of colourless glass (5) - a pack cardboard.
10 ml - bottles of colourless glass (10) - a pack cardboard.